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_ _. � _�_�._._.__—�__.._...,_--- -� ,.�_ — - ` ..W...._.�„,,:,_.:,.;:.._.,...�- CTTY OF DIAMOND BAR ��� COMMUNTI'Y DEVELOPMENT DEPARTMENT �:,; . 1;� 21660 E.Copley Drivc Suite l90 (909)860�3195 Fax(909)861-3117 �;! , �� PRESS "'"" BUILDING PERMITAPPLICATION FIRMLY oy JOBSITE ��,5�'j t�������� �T.., APPUCATION . � �j"j IT m P/C � � ADDRESS DATE �NUMBER 'v O #� $ ISSUE � TYPE OCC APN LOT� TRACT ��C�B'� I DATE CONST. GROUP p OWNEF ��+G �-)C1^rl r'�'S " ADDRESS TE�+'�h���.- ' ' t,, ZONING SETBACKS z cinr 33�.'�*���- Z TEL." "" REART RW ❑❑ � APPLICANT I/�('�.�C�� -�+sAl� TEL.tslCi'i7}"�"7s� SIDElSIDESTREET RW�_ :_] CONTRACTQR �"n'� �%"'���+� SIDE ❑ � ADDRESS L '1 L.s'`�^�� S �'�vvr.T ' �r:,� _.a y o CITY a�AY��.t�C-rf3 �,ZIP TELLG+� `�.�3 '�' PROPOSED USE �� o ARCH/ENG/�.��..� � ���,G-. �'�9G�, z DESIGNER w NO.DWEL. NO. NO. a ADDHESS tL�� 6 �7= Z,��-� UNITS STORIES ' BEDROOMS � CITY���A�J��i ZIP C���TEL:�IC:�"1A-'�a"Z'9C��` cn DESCRIPTION SQ.Fi: FACTOR PSF ADJ.AREA/VALUATION p� OWNER-BI:ILDER DECLARATION � 0 � SFR/ADDlREM �(,� I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT t AM EXEMPT FROM THE CONTqACTORB LI- G8�8g9/CBfpOr1 W CENSELAWFORTF1EFdlOWINGREA50N(SEC.7o37.5BU31NES5ANDPilOFE551ON5CODE:ANYCfIYOR (n U CWNTYWHICHHEOUIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE,OEMOUSN,ORREPAIRANYSTflUG W PB�IOIDBCI( Z TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PEflMIT TO F�LE A SIONED � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PqOVI510N5 OF 7HE CONiRACTOHS LI- � � CENSE U1W(CHAPTER 9(COMMENCINO WITH SECTION 7000�OF DIVLSION 9 OF 7HE BUSINESSAN�Pq0- POOVSpe O FESSIONSCODE)ORTHATNEORSHEISEXEMPTTHEREfHOMANDTHEBA515FOqTNEALLEOEDpCEMP- (� V TION.ANYVIOLATIONOFSECTION7081.6BYANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z qe.qoot A CIVIL PENALTV OF NOT MORE THAN FNE HUIORE�DOLURS(5500).): ZCI,ASOWNEFOFiHEPROPERTV,ORMYEMPLOYEE5W17HWACESASTNEIflSOLECOMPENSATION, 0 COTfl16rC181 WILI DO THE WORI(,ANU THE STRUCNRE IS NOT IN7ENOED OR OFFERED FOR SAIE ISEC.701a,BU51- J � NESSAND VROFESSIONS CODE:THE CANTMCTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF ? PROPERTY WFIO BUILD30R IMPROYESTHEREON,AND WNO DOES SUCH WORKHIMSELFOR HERSELF ON � THHWGHMISOFHEROWNEMPLOVEES,PPOVIDEOTHATSUCHIMPROVEMBJTSARENOTINTENDEDOR m QoFFEREDF4RSALE1f,HOWEVERTMEBUILDINGORIMPROVE4IENTIS50LDWITHtNdJEVEAROFCOMPLE- Z TION,7HE OWNEA-BUItDER WILL HAVE 7HE BURDEN OF PROVINO THA7 HE OR SHE DID NOT BUIID OR , � MAPROVE FOq THE PURPOSE OF SALE). i ❑I,ASOWNEROFTHE PROPENTY.AM EXCLUSIVELY CONTRACTING WITH UCENSEDCONTRACTOflS Q TO CONSTRUC7 7HE PHOJEGT�SEC.7061,BUSWESS ANO PROFESSIONS COUE:THE CONTIiACTOqS LI• V8111a11011 ADJ.AREA W CENSEUWDDESNOTAPPLYTDANOWNEROFAPROPERTYWHD9UILDSORIMiROVESTHEREON,AND � � WFIOCONiRACTSFORSUCHPqOJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTMG QUANTITV DESCRIPTION FEE Y TORS LICENSE LAW.). A � ❑I AM EXEMPT UNDER SEC. B.8 P.Q FOR THIS HEASON Q I .j�� �'M^-� /✓/'M-C.!/rT 6. � � C%�4 s-F�S u' DATE OWNER U � W � LICENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRM UN�ER PENALTY OF PERJURY THAT 1 MI UCENSW UNOER PROVISIONS OF CHAPTER � d 9(COMMENCING WITH SECTION 700D)OF DiV1510N 70F7HE BU51NE5S AND PROFESSIONS CODE,AND Z X MY LICENSE IS IN FULL FORCEAND EFFECT. m LLl S y_�s,��� � � LICENSE CUlS� ri LIC.NO. •-� -7 � v onre �' ���1 CONTRACTOR C.x7Va'�.�'C.uV+'-�� a w �� /�.� � WORKERS'COMPENSATION DECLARATION �,�4JY�7 rl � /`� v � I HEHEBY AFFWM UNOER PENALTV OF PERJURV ONE OF THE FOLLOWING OECJ1Hp71DNS: Z � _I HAYE AND WILI MAINTqIN A CERTIFICATE OF CONSENT TO SEIF-INSURE FOR WORKE(i3' _ Q CONPENSATION,AS PHOVIDED BY SECTION 37000F THE UBOR CODE,FOH TNE PENFORMMICE w Q �OF THE WORK FOR WHICH THIS PERM�T IS ISSUED. � ¢w I HAVE AND WILL MAINfAIN WORKERS'CAMPENSATION INSUMNCE,AS REWIRED 8Y SECTION / 3�00 OF THE UBOR CADE.FORTME PERFORMANCE OF THE WORK FOR WHICH7HI3 PERMR IS /� Q �� � ISSUED.MY WOPo(ERS'COMPENSATION INSURANCE CMRIER AND Pq.ICY NUTABERARE: CONSTRUCTION do-� • — Q r �U�� � CARRIEH �O'��V PLAN REVIEW s 8p� .�J�� "'�'��' ¢ POLICY NUMBER f� /Y7 f.'���' �� ELECTRIC —��* �� d�• � (MISSECiIONN�N078E07�4�lEfIDOF7FEPEfibRISFORONEFiIRDii�00l1ARS(Sf0010R� PLUMBING _ Z 1 CERTIFV iNAT IN THE PERFOFNANCE OF THE WO OH WH PERMIT IS O.I MECHANICAL C!3 SHALLNO7EMPLAYANVPERSONINANYMAN SO i COMESUBJECTTOTHE � WOHKEHS'COMPENSATION UWS OF CALIFO 10.AND E THAi iF 1 SHOULD BECOM INSPECTION FEE � SU&IECT TO THE VYORKEflS'CAMPENSAT ROVISION OF SECTION 97000F THE IA8 „�� � CAOE.I SXN1 FORTHWI7H COMPLY WITM SE PROV ONS. �SSUANCE � � � 2!L� �.� p DATE: . APPLICANT:' SMIP J WAFWING:FARURE TO SEWRE WORKERS'COLIPENSATION CAVERA�E 1 WFUL,AN�SHALL BE ENERGY P/C y � � SU&IECTANEMPIOYERTOCRIMINALPENILLTIESANOCIVILFINESUPTOONEM DREOTHDUSAND ENERGYPERMIT DOLURS(5700,000).W ADDIiION TO THE COST OF COMPENSATION,DNAAGES AS PROVIDED FOR IN � SECTION 37oeOF THE LA9OR CODE.INTEREST,ANDATTORNEV'S FEES. RETENTION FEE: a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � t HEHEBV AFFI0.M Uf�ER PENALTV OF PER1UqV THAT THERE IS ACONSTRUCTION LENDINO AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMITIS ISSUEO(SEC.9007.CIV.C.). Z W � LENDER'SNAME � H LENDEH'SA�DRESS ¢ ICERTIFYTHATIHpVEREADT1115IVPLICATIONANDSTA7ETHATTHEA60VEWFOR1AATqNISCORRECL TOTAL FEES ^� S ` ,��''�7 • ✓" �' �S � IAGREE TO COMPLY WITrI ILLLCITYAND COUNTY ORDINMJCEfi AND STATE LAWS REUTING M BUILDIN� � CONSTRUC7I N YAUTHORREREP TIVESOFTHISCOUNTYTOENTERUPONTHE Z A80VE•M ED PfiOPE T!fON I PUR 0 COMMENTS = p.2 �'rt.'a►�a t a PERMI E NAME IPRI yq�� � � � �f � SIONATUREOFP DATE RECPT.NO. !��f Y��' PAID BY G��Co°'f6�i VAUDATION � WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessa Capy.GOLOENROD--File Copy,GHEEN—Applicent's Copy ------- ----�.__.�._._.........�.._-�.-.�.�..+��ee.w.+mM•�.,.....,..__..._-___�__......__....�,......,.,�,wx CITIP.QF �IA�A�ii��.��� � ,.. . . , qM�lP��"�fC.�� '�����f� . _ , _,...<._ . .,_. -:. -r_ ° �� � a� • , e e � ..� , .._.... .-�a . ._ ., . ._�..,.., .' `" ......._""_..__.-,.___ ....._.._.__. . _._._.... . SET BACK.: " : t �. a -F�OC�P,lOIS f. _.... _ _ _' - - -c-�-----------+-+ . 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